JMIR Publications

ABSTRACT

Background:

Over the last decade telemedicine services have been introduced in the public healthcare systems of industrialized countries. In Catalonia, the use of eConsulta, an asynchronous teleconsultation between primary care professionals and citizens in the public healthcare system has already reached one million cases. Before the COVID-19 pandemic was growing at a monthly rate of 7%, and the growth has been exponential from march 15th until now. Despite its widespread usage, there is little qualitative evidence describing how this tool is used.

Objective:

To annotate a random sample of these teleconsultations and to evaluate the level of agreement between healthcare professionals with respect to the annotation.

Methods:

20 General Practitioners retrospectively annotated a random sample of 5,382 cases managed with eConsulta according to 3 variables: the type of interaction according to 6 author-proposed categories, whether the practitioners believed a face-to-face visit was avoided, and whether they believed the patient would have requested a face-to-face visit had eConsulta not been available. 1,217 cases were classified three times, by three different professionals, to assess the degree of consensus among them.

Results:

In response to the question “Has the online consultation avoided a face-to-face visit?”, GPs answered Yes for 79,6% (4,284/5,382) of the teleconsultations, while to the question “In the absence of a service like eConsulta, would the patient have made a face-to-face visit?” GPs answered Yes 65% (3,496/5,382) of the time. The most frequent uses were for management of test results (26.8%, 1,433/5,354), the management of repeat prescriptions (24.3%, 1,301/5,354) and medical enquiries (14.2%, 762/5,354). The degree of agreement among professionals as to the annotations is mixed, with the highest consensus being for the variable “Has the online consultation avoided a face-to-face visit?” (3/3 professionals agreed 68% of the time (827/1,217), and the lowest for the type of use of the teleconsultation (3/3 professionals agreed 57.6% of the time, 701/1,217).

Conclusions:

This study shows eConsulta’s ability to reduce the number of face-to-face visit stands at between 55% (79% x 65%) and 79% of cases. In comparison to previous research, these results are a bit more pessimistic while figures are still high and in line with administrative data’ proxies, which show 84% of teleconsultations do not register an in-person appointment in the following 3 months. With respect to the type of consultation performed, results are similar to previous literature, thus giving robust support to the eConsulta’s usage. The mixed degree of consensus among professionals implies that results derived from AI applications such as message classification algorithms should be understood in light of these shortcomings. Clinical Trial: The study was approved by the Ethical Committee for Clinical Research at the Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina, registration No. P19/096-P.